ACR Bulletin

Covering topics relevant to the practice of radiology

Two Sides of the Same Coin

How a radiology ratings website could balance quality metrics with costs to the patient — all while helping to prevent radiologists from becoming commoditized.
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Although in our particular situation, price wasn’t top of mind, pricing often plays a crucial role in how patients choose medical providers, including radiologists.

August 05, 2019

From the moment I saw my son at school, I knew something was wrong. He was crying inconsolably and holding his elbow in flexion. We drove straight to a children’s ER, and the X-rays told the story: my 6-year-old had a displaced lateral condylar fracture, which would require surgery.

As an educated healthcare consumer, I immediately got on the phone to former medical school classmates and colleagues. I wanted to ensure that the orthopedic surgeon we were assigned to was qualified to perform the surgery. Fortunately, he was well known by my clinical colleagues and a skilled surgeon according to orthopedics residents. However, on the day of the procedure, my son’s surgery was bumped for a more emergent procedure that our assigned surgeon had to perform.

“Don’t worry,” the operating room manager said. “We have found another surgeon. His operating room is open and we can take your son back now.”

My husband, also a radiologist, and I looked at each other in shock and panic. We immediately were on our phones, googling this new surgeon’s name; however, there was nothing available except his picture on the hospital system’s website. A million questions ran through my mind: Who was he? How many elbow fixations had he done? Was he an elbow specialist? What were his complication rates?

In the end, my son’s surgeon was more than qualified, as was confirmed by the hospital’s radiologist when he told us, “He can do these fixations in his sleep.” Happily, my son has completely healed from his fracture. But after being in the caregiver’s shoes that day, I realized we can do better as a profession.

The Importance of Transparency

This real-life experience highlights an important issue in our healthcare system: a lack of transparency. In our case, it was a paucity of data on quality metrics by which to compare surgeons. Without knowing any physician colleagues who had dealt with the surgeon in question and with no online tools available that painted an accurate picture, we had to leave our decision up to fate.

Although in our particular situation, price wasn’t top of mind — the first question when I sought care for my son was not, “Where is the most cost-effective facility?” — pricing often plays a crucial role in how patients choose medical providers, including radiologists. In this sense, price transparency and quality transparency are two sides of the same coin.

Although the two concepts are closely related, the medical community is still searching for an effective way to discuss how to balance the cost of services rendered against the quality of those services. Price transparency has been highlighted in policy discussions, but the notion of “quality” is often missing from the equation.

This is a problem, because when patient consumers predicate their healthcare decisions solely on price, radiologists run the risk of becoming commoditized. As a consequence, radiologists lose any incentive to provide high-quality care — and become easily replaceable.

A Ratings System

As important as this quality conversation is, however, there is no reliable system for rating physicians in general, and radiologists in particular. As a partial course correction laid out by the Affordable Care Act, CMS has implemented their Physician Compare website where quality data about physicians is published. However, the only information currently published includes whether or not a physician successfully reported into the Medicare Quality Payment Program. It certainly did not provide the information I needed when deciding where I should take my son for his surgery.

What if we had a system for rating radiologists? On such a site, costs to the patient would undoubtedly be taken into consideration but so too would quality metrics. Healthcare providers and patients would be invited to rate physicians, using important metrics that might impact patient care as guidelines.

One example of an entity already engaged in such rating activities is the Cleveland Clinic. The Clinic publishes their outcomes on an annual basis, comparing themselves to recognized benchmarks. Similarly, a ratings website for radiologists could highlight patient-reported outcomes.

On this website, patients would be invited to provide feedback on the care they received but not in punitive terms. Reported metrics could include patients’ ease of understanding their medical condition based on radiology reports, or availability and access to images or a radiologist when needed. Perhaps the ACR and other radiology organizations could develop meaningful patient-reported metrics linked to outcomes.

Metrics Development

A good starting place for developing these metrics might be to ask a simple question: What important elements do radiologists contribute to patient care? More importantly, let’s ask patients what they need to know before selecting their care. We could begin with just one measure and build out from there, say for instance, the minimization of missed clinically relevant findings that may impact treatment or save a life.

I realize the hurdles of achieving this higher level of transparency — including the resources required to collect data — are many. In all honesty, this level of transparency in my own work makes me uncomfortable. But when it comes to our personal healthcare or those of our family and friends, we seek out this information when we ask for personal recommendations. Shouldn’t all patients have access to this information as well?

Author Melissa M. Chen, MD,  vice chair of the Economics Committee of ACR’s Patient- and Family-Centered Care Commission